Pubdate: Sat, 18 Feb 2017
Source: Record, The (Kitchener, CN ON)
Copyright: 2017 Metroland Media Group Ltd.
Authors: Anam Latif and Liz Monteiro
Page: A9


WATERLOO REGION - Sally has been taking drugs since her mother
introduced her to them when she was 14.

Today, the 26-year-old Kitchener woman is on methadone to curb her

But Sally, not her real name, still does illicit drugs like crystal

Her drug of choice is crack but last summer while looking for a hit,
she bought a "point" of fentanyl and injected it (a point is one-tenth
of a gram). She doesn't want to do it again but fears it could be
laced in the drugs she usually buys.

Alex, not his real name, will do whatever he can to get his hands on
some Percocets, which contain oxycodone and acetaminophen.

A few years ago he started swallowing the potent painkillers.

Then he began chewing them to get a faster rush. Now he crushes up the
pill, dissolves it in liquid and injects it.

Alex says he has tried to quit but he can't.

"You need a steady flow," he says of the strong opioid. Alex continues
injecting pain pills to avoid the painful withdrawal symptoms.

As soon as Alex gets out of bed he shoots up. Then he'll do it again
in the evening when the drug wears off.

"I don't buy groceries, I buy drugs," says Alex, who pays his rent and
then spends the rest on drugs. He receives a monthly disability pension.

For Alex, a transgender man, life has been difficult. He's been called
names. He left his family behind and moved to a new place. He takes
the drugs to make the pain subside.

"I just hope I don't run into fentanyl," he says.

Waterloo Regional Police say fentanyl is being cut with other drugs
such as heroin, cocaine and meth and often users may not know how much
they are getting. Some of the "hot spots" can be deadly, they say.

Jason has tried fentanyl a few times. He smoked the sticky, gummy
residue from a used prescription patch once. Another time he mixed it
up with vitamin C and injected it.

But the potent drug didn't have much of an effect on Jason because he
was also taking methadone at the time.

Methadone blocks the euphoric effects of other opioids, which is why
it is seen as an effective treatment drug for addicts, according to
the Centre for Addiction and Mental Health.

Jason, not his real name, says he used opioids while taking the
treatment drug because all he wanted was to feel the euphoric high

"Opioids can really blindside a recreational drug user," Jason says.
"They can turn a recreational user into an addict overnight."

He knows because it's what happened to him.

When he was a teenager, Jason dabbled in hallucinogenic drugs like LSD
and mushrooms.

He had never tried anything stronger until he moved to Waterloo Region
with his mother and her boyfriend.

They all got hooked on pain pills.

"It wasn't like I had to run off out of the house to do a drug,"
Jason, now in his 30s, recalls. He would crush up various pain pills
and snort them.

He didn't inject drugs until he started taking methadone. He hoped
taking the drug intravenously would help him get high again.

The urge to get high is what led him to injecting pain pills. It's
also what led him to fentanyl patches.

Up to 80 times stronger than morphine, fentanyl is typically
prescribed in the form of slow-release patches that stick to the skin.

A decade ago, Jason says, addicts could buy used fentanyl patches on
the street for about $20 a piece.

Now, they are not readily available. That's because of new provincial
legislation which forces patients to return used patches to pharmacies
before they can get a new one.

Jason says he has heard of used patches selling for up to $200

It's actually cheaper to just buy heroin, he adds.

And now illegal powdered fentanyl is hitting the streets of Waterloo

It's a scary thought even to Jason.

"I can see the pure powdered fentanyl can very easily be dangerous,"
says Jason, who used to sell legal prescriptions to users.

"How would you even measure it?"

As little as two milligrams of the stuff can be lethal, that's the
amount of a few grains of salt.

Jason says even if the drug is cut with other products to weaken its
effect, there is no guarantee of what you're actually getting.

Violet Umanetz with Sanguen Health Centre goes out with a mobile
health van twice a week to help street drug users.

"It can be difficult to get information out to someone who isn't
housed or doesn't have access to media, for example," says Umanetz, an
outreach worker with Sanguen, a health unit that provides support to
vulnerable populations.

In addition to their focus on hepatitis C support and harm reduction,
they also hand out naloxone kits. In three years, Sanguen has
distributed more than 170 naloxone kits through its mobile health van
and from its clinic in Waterloo. It recently switched to nasal
naloxone, which is easier to administer.

Kits are also available at Region of Waterloo Public Health, Grand
River Hospital and some local pharmacies.

Umanetz says there is a common misconception that overdoses are always

"A lot of overdoses go unreported," she says.

That's part of the reason why Umanetz says education is important so
people who use drugs know what to do, how to spot an overdose and who
to call if someone is at risk.

The stigma around drug use needs to change, she says. "People think,
'If I'm overdosing I probably don't want to call the police or EMS.'
Some people may think no one cares."

Sanguen is constantly updating its approach to harm reduction. They
speak to active drug users and give them flyers on how to administer
naloxone and how to report an overdose.

"We need to continue to educate the community about drugs," Umanetz
says. "We can't be everywhere at once."

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Opioid primer

Opioids are potent painkillers that have morphine-like effects. They
can be found in nature (opium poppies) and are produced in your brain
(endorphins). Opioids can also be created in pharmaceutical labs and
illegally in clandestine labs.

How do they work?

Opioids affect the body by binding receptors found in your brain and
other organs. The receptors are proteins in cells that interact with
the drug.

What do they do?

When opioid receptors are activated you can feel pain relief, euphoria
and sedation. The drug also suppresses coughs and can cause nausea,
vomiting, constipation and sweating. Your pupils get smaller. Opioids
can create physical dependence and tolerance. The drugs can also cause
respiratory depression. If your breathing slows down too much you can
overdose and die.

How does naloxone work?

It's essentially a temporary opioid-receptor blocker. "It's going to
get into the brain, latch onto the opioid receptors but not activate
them," says Michael Beazley, a pharmacologist and professor at the
University of Waterloo's School of Pharmacy. "It will compete and kick
off the drug and reverse the overdose."

Naloxone's reversing effects only last 30 minutes and an ambulance
should be called when administered. Each kit comes with two nasal
pumps in case a second dose is needed because stronger strains of
opioids, like fentanyl, may need more than one dose.

That's because fentanyl is 80 times more powerful than morphine,
Beazley said. Assume you can overdose on 200 mg of morphine, he
explained. Then that means one kilogram of morphine can cause 5,000
overdoses. If you compare it to fentanyl, one kilogram of that stuff
can cause 400,000 overdoses. An effective dose of prescription
fentanyl is 0.1 mg. A lethal dose is 2 mg. Examples of other opioid
drugs include hydromorphone, codeine, oxycodone and methadone.

Bootleg fentanyl

Bootleg fentanyl is believed to come from China and is sold in pill or
powder form. Because it's produced in uncontrolled environments, the
strength of illicit fentanyl can vary greatly.

Watch a video on how to administer naloxone produced by the University
of Waterloo's School of Pharmacy and Region of Waterloo Public Health.
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